Provider First Line Business Practice Location Address:
1210 DRY HOLLOW RD STE 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THE DALLES
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-710-5709
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2013